Next time you visit church, a park or playground, or
a kid-friendly restaurant, think about the fact that half of all births in
Alabama are paid for by Medicaid. That's right, one out of two. You might think
you can tell which of those children had Medicaid-paid births, but you might
be wrong. In the interest of the babies, Alabama decided several years back to
give all pregnant women whose income is below 133% of the federal poverty level
access to Medicaid.

Now our governor has to make a decision regarding
accepting or rejecting an expansion of Medicaid aimed at offering not just newborn
babies, but all Alabamians, more
generous income-based Medicaid coverage. Many Republican governors have
refused the expansion---but not all. Witness Ohio's Governor John Kasich decision
this past week to take the money, feeling that it's in the best
interest of the state for him to do so. According to Politico, Kasich said, "I don't view
this as Obamacare at all... This is about people who are at the lower
economic end." The article went on to say that "hospital officials and leaders of the
Cleveland Clinic have been telling Kasich it's smarter economics to take the
feds' Medicaid money than to pass it up."

Would it be smarter economics in Alabama? After all,
if Governor Bentley accepts the expansion, he commits the state to an
additional $1 billion in health care payments over the next 10 years. But some
of this is money we are spending already such as for emergency room
visits for those now uninsured.

In exchange, there will be an additional $14
billion that comes into the state and can be used by Alabamians for care. Let's follow some of that money.

According to the Alabama Rural Health Association, $1.2
million annually stays in the community every time a doctor relocates
to a town. This money is paid to (and spent by) not only the doctor but to
nurses, clerks, and other health care professionals. What attracts these doctors to Alabama towns
and keeps them there? One factor is the ability to make a living. Large numbers
of uninsured patients or an underfunded Medicaid system make it less likely
that primary care doctors will make their way to Alabama towns.

Secondly, every industrial recruiter knows that new
jobs end up where health care and education already exist. Take Thomasville. Although
Mobile is only ninety minutes away, that's a long way for a young parent with a
feverish child to drive. Thomasville has several primary care physicians, but
their hospital recently closed, citing inadequate revenue. When more
Alabamians have health insurance, communities will have opportunities to
attract investment in health care infrastructure, creating jobs not only in
healthcare but in other industries too.

Now back to those Medicaid deliveries. If
entitlements work as we all fear, paying for deliveries for all women should have
increased the number of folks having "free" babies. Instead, just the
opposite happened. Health statistics show that birth rates in Alabama have fallen
among all age groups, incomes, and races. This is because, in part, the extra money
was used to change the system. Birth control was made more accessible, leading
to fewer unplanned pregnancies. Care was improved for pregnant patients with
diseases such as diabetes. This helps avoid medical complications during
pregnancy or birth. Even though we are paying a little more for prenatal care
and deliveries, taking everything into account the overall cost is less
and the care is better.

Let's extend these results to all Alabamians. Right
now, 55% of our Medicaid dollars go towards care of the elderly and the
disabled, even though they only account for 25% of those enrolled in the
program. Money is now spent on
nursing home care and emergency room
services that could be better spent on home care and primary care services. Our
Medicaid is in crisis, because we buy very expensive care late in the process that is not very
effective.

You might say we're
putting out fires with gallons of bottled water, instead of buying a $10 smoke
detector.

The governor has stated that Medicaid, in its current form, is not
acceptable. Let's take advantage of this expansion to follow the Governor's
Commission on Medicaid's suggestions and reorganize Medicaid, focusing on the
right care always; effective care in the community when possible; and cost
effective health care leading to better health that we can proudly use to
recruit industry to Alabama.

Dr. Perkins is Professor and Chair of Family Medicine at
the University of South Alabama College of Medicine in Mobile. The opinions he
expresses are his own.